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Fact Sheet: Electronic Health Record Incentive Program and Health IT Certification Program Final Rule

Date
2015-10-06
Title
Fact Sheet: Electronic Health Record Incentive Program and Health IT Certification Program Final Rule
Contact
go.cms.gov/media

Fact Sheet: Electronic Health Record Incentive Program and Health IT Certification Program Final Rules

Shared Goals

Patients, providers, businesses, health plans, and taxpayers all have a common interest in building a health care system that delivers better care, spends health care dollars more wisely, and makes our communities healthier – all with the patient at the center of their care.  

Electronic health records are critical to this effort. We want actionable electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange information.

Electronic health records offer providers easy access to patient information; a series of tools, such as clinical alerts and reminders to support clinical decisions; enhanced communication with other clinicians, labs, and health plans; documentation that facilitates accurate coding and billing; and safer, more reliable prescribing. Patients benefit from less paperwork, reminders of important health interventions, convenience of e-prescriptions, and an avenue for communication with their providers.  Moreover, electronic health records (EHRs) can expose potential safety problems when they occur, leading to better patient outcomes.

We Have Made Progress but Have More Work to Do

Over the past several years, we have seen increasing numbers of physicians, clinicians, and hospitals using EHRs to improve patient care. More than 70 percent of eligible physicians and other clinicians and more than 95 percent of eligible hospitals have successfully used EHRs and received incentive payments from the federal government.  That represents great progress from the days when a doctor’s handwriting needed to be interpreted and paper records could be misplaced.

We recognize we have more to do. We have heard from physicians and other providers about the challenges they face making this technology work well for their individual practices and for their patients. Doctors in particular have expressed ongoing concern over increasing requirements for the use of EHR technology and frustration at competing reporting requirements among programs. Providers also have described the challenge of planning for and reporting on complex and numerous meaningful use requirements.

In recognition of these concerns, the regulations we are announcing make significant changes in current requirements.  They will ease the reporting burden for providers, support interoperability, and improve patient outcomes. For example, the regulations:

  • Shift the paradigm so health IT becomes a tool for care improvement, not an end in itself.
    • Commenters asked us to remove many of the “check box” process measures and we did. Commenters wanted the program to focus on better care for patients such as clinical decision support, electronic prescribing, and information exchange and we have enhanced the focus in these areas.
  • Provide simplicity and flexibility so that providers can choose the measures of progress that are most meaningful to their practice.
    • Commenters asked us to reduce the burden and duplicative reporting, including reporting on measures that are irrelevant to their specialty. We reduced the number of objectives from 20 to less than 10 and provided flexibility so that providers may choose measures that are most relevant to their practice. We also aligned certain aspects of the reporting of clinical quality measures with other CMS Medicare quality reporting programs, enabling providers to report once and receive credit for multiple programs.
    • Commenters asked us to give them adequate time to implement changes to program requirements, so we are allowing 90 day reporting for all providers in 2015, extending the 90 day reporting period to new providers in 2016 and 2017, and to anyone choosing to adopt the 2018 measures a year early.
  • Give providers and states more time – 27 months, until January 1, 2018 - to comply with the new requirements and prepare for the next set of system improvements.
    • Commenters told us that 2017 is not a realistic start date, so we made the effective date 2018, making the program optional for providers in 2017.
  • Give developers more time to create the next advancements in technology that will be easier to use and more appropriate to new models of care and access to data by consumers.
    • Commenters asked for longer time to develop products based on new certification expectations and this rule provides them with 27 months.  In addition, we finalized fewer criteria and focused on interoperable exchange (e.g., inclusion of an improved common clinical data set for exchange and supporting application program interface (API) functionality).  By finalizing fewer criteria, developers will have additional time to develop innovations and create usability-focused EHRs.
  • Address health information blocking and interoperability between providers and with patients.
    • Commenters recommended we emphasize measures that focus on interoperability instead of those that focus on data entry. We modified the measures so that more than 60 percent of measures rely upon exchange of health information, compared to 33 percent previously.

We are Transitioning to a New and More Responsive Regulatory Framework

This new framework will be based on the landmark bipartisan legislation -- the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – that requires the establishment of a Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs for Medicare physicians and other providers into one more efficient framework.  We view the regulations released today as a bridge to the new payment system for physicians and providers and look forward to receiving input about how best to incorporate the EHR Incentive Programs into the new payment system. This rule moves us beyond the staged approach of “meaningful use” by 2018 and helps us collectively move forward to a system based on the quality of care delivered, as opposed to quantity. We will use this feedback to inform future policy developments for the EHR Incentive Programs, as well as consider it during rulemaking to implement MACRA, which we expect to release in the spring of 2016 and other rulemaking as appropriate.

As part of today’s regulations, we are announcing an additional 60 day public comment period to facilitate additional feedback about our vision for the EHR Incentive Programs going forward.  In addition, we will engage in actively listening to key stakeholders through meetings and outreach. HHS is committed to working with physicians, clinicians, hospitals, consumers, and other stakeholders to make these programs as effective as possible. We want to use this time to pause and reflect about how the safe, secure exchange of actionable electronic health information can best be used to deliver better patient care and how to create an infrastructure that supports that. We also want to use this time to talk to stakeholders about their views on the vision we have laid out today, as well as what should be done in the future.

In the interim, although the majority of physicians have not received negative payment adjustments under Medicare, we know that some physicians are not ready to qualify for the EHR Incentive Programs and are concerned about these adjustments. We intend to use our administrative flexibility as much as we can to help physicians and other providers who are making efforts to adopt and use this technology to succeed.  We encourage providers to submit requests for a significant hardship exception from the payment adjustment through the existing request process. We are pleased that most providers have been successful in adopting and using the technology and we want to work with those who are still transitioning to the use of EHRs.

What does this mean for patients?

  • Patients will have unprecedented access to their own health records, empowering individuals to make key health decisions.
  • The sharing of information among providers helps consumers avoid unnecessary tests and treatments, reducing consumers’ costs and improving safety.

What does this mean for providers?

  • In 2015, providers need to report on their use of EHRs for any continuous 90 days within Calendar Year 2015 (or within the period October 1, 2014 – December 31, 2015 for hospitals) by February 29, 2016. This may be extended to the end of March if providers need more time.
  • For 2016 and 2017 for both Medicare and Medicaid providers (and 2018 for Medicaid providers), providers that are new to the EHR Incentive Programs need to have additional flexibility and can report on any 90 days.
  • Health care providers are actively working to improve the way they deliver care by better using technology today, and change takes time, so most of the changes aren’t required until 2018, allowing time to plan. For providers who are ready to move forward, they can transition to the next phase in 2017.
  • For Medicare providers experiencing difficulty, CMS encourages applying for hardship exceptions, which are reviewed on a case-by-case basis. For example, providers switching EHR vendors or who have other technology difficulties may be eligible for a hardship exception.

What does this mean for developers?

  • HHS recognizes the importance of providing sufficient time for developers to develop and certify new products for EHR Incentive Program compliance, as well as allowing sufficient time for providers to implement new technologies and adapt workflow. These rules provide a period of 27 months from final rules to compliance during which developers will be able to develop and certify their products and help providers fully implement those products into their practices so that they can begin meeting the EHR requirements in 2018.
  • Developers can now begin developing health IT products, including EHRs, which they intend to have certified to the 2015 Edition certification criteria requirements. Any modifications that CMS considers for the EHR Incentive Programs or MIPS would be proposed in future rulemaking and would take into account the certification criteria available through the ONC Health IT Certification Program and the 2015 Edition final rule, as well as the time needed for product development and certification.
  • Developers will now be able to begin development of improved transitions of care and innovative API functionality.  APIs support the patient’s ability to access their health information in increasingly flexible ways, including by being able to enable easier access to health data for patients via mobile devices. The 2015 Edition final rule provides more expectations about system security, which should be a top priority for developers.
  • ONC will continue to work with developers and the Health IT community to highlight provisions of the 2015 Edition Final Rule that strengthen the ONC Certification Program, including the provisions on in-the-field surveillance.
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